From the Department of Plastic Surgery, University of Texas MD Anderson Cancer Center.
Plast Reconstr Surg. 2024 Mar 1;153(3):717-726. doi: 10.1097/PRS.0000000000010810. Epub 2023 Jun 6.
It is not clear whether mesh-reinforced anterior component separation (CS) for abdominal wall reconstruction (AWR) results in better outcomes than mesh-reinforced primary fascial closure (PFC) without CS, particularly when acellular dermal matrix is used. The authors compared outcomes of CS versus PFC repair in AWR procedures aiming to determine whether CS results in better outcomes.
This retrospective study of prospectively collected data included 461 patients who underwent AWR with acellular dermal matrix during a 10-year period at an academic cancer center. The primary endpoint was hernia recurrence; the secondary outcome was surgical-site occurrence (SSO).
A total of 322 patients (69.9%) who underwent mesh-reinforced AWR with CS (AWR-CS) and 139 (30.1%) who underwent AWR with PFC (AWR-PFC) without CS were compared. AWR-PFC repairs had a higher hernia recurrence rate than AWR-CS repairs (10.8% versus 5.3%; P = 0.002) but similar overall complication (28.8% versus 31.4%; P = 0.580) and SSO (18.7% versus 25.2%; P = 0.132) rates. CS repairs experienced significantly higher wound separation (17.7% versus 7.9%; P = 0.007), fat necrosis (8.7% versus 2.9%; P = 0.027), and seroma (5.6% versus 1.4%; P = 0.047) rates than PFC repairs. The best cutoff with respect to hernia recurrence was 7.1 cm of abdominal defect width.
AWR-CS repair resulted in a lower hernia recurrence rate than AWR-PFC but, despite the additional surgery, had similar SSO rates on long-term follow-up.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
对于腹壁重建（AWR）手术，使用无补片加强前层分离（CS）的网片加强修补是否比不使用 CS 的网片加强原发性筋膜闭合（PFC）效果更好，目前尚不清楚，尤其是在使用脱细胞真皮基质的情况下。作者比较了 CS 与 PFC 修复在 AWR 手术中的结果，旨在确定 CS 是否能带来更好的效果。
这是一项回顾性研究，对 10 年间在一家学术癌症中心接受 AWR 并使用脱细胞真皮基质的 461 名患者前瞻性收集的数据进行了分析。主要终点是疝复发；次要结局是手术部位并发症（SSO）。
共比较了 322 例（69.9%）接受 CS 网片加强 AWR（AWR-CS）和 139 例（30.1%）未行 CS 的 AWR 加 PFC（AWR-PFC）的患者。AWR-PFC 修复的疝复发率高于 AWR-CS 修复（10.8%比 5.3%；P=0.002），但总并发症（28.8%比 31.4%；P=0.580）和 SSO（18.7%比 25.2%；P=0.132）发生率相似。CS 修复的伤口分离（17.7%比 7.9%；P=0.007）、脂肪坏死（8.7%比 2.9%；P=0.027）和血清肿（5.6%比 1.4%；P=0.047）发生率明显高于 PFC 修复。关于疝复发的最佳截断值为 7.1cm 的腹部缺损宽度。
与 AWR-PFC 相比，AWR-CS 修复的疝复发率更低，但在长期随访中，尽管增加了手术，SSO 发生率相似。
临床问题/证据水平：治疗性，III 级。
